As a pregnant woman, I can’t help feeling like I’m being clobbered with a great big stick.

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I’ve already complained about the guidelines for alcohol consumption during pregnancy, but having attended the press conference regarding alcohol consumption and sperm counts, I can’t resist pointing out what could be a major flaw in its conclusions – or at least how they’ve been reported.

Harsh judgements

Cecilia Ramlau-Hansen of Aarhus University Hospital in Denmark told a meeting of the European Society of Human Reproduction and Embryology what she had found when she compared men’s sperm counts with the amount of alcohol that their mothers said they had drunk in the months before they gave birth to these sons. The sons of mothers who drank more than 4.5 alcoholic drinks a week during late pregnancy – a drink being one 330-millilitre beer or a 120-millilitre glass of wine – had average sperm counts of 25 million per millilitre, making them “sub-fertile” according to the standard classification. The sons of mothers who drank the least had average sperm counts of 40 million/ml.

What’s odd about the study is that women classified as drinking “more than 4.5 drinks a week” could actually have been drinking anywhere between 4.5 drinks a week and 20 drinks a week, because women consuming up to 20 drinks a week were included in the same category. It’s therefore quite possible that a handful of women who drank huge amounts of alcohol during pregnancy might have skewed the results – something the researcher herself admitted, but few media outlets chose to report.

Non-smoker? We’ll see

I also bristled at the news that pregnant women in the UK could soon be breathalysed to determine whether or not they smoke. But given the harm that smoking can do to fetuses, I decided to see if the idea could perhaps be justified.

There’s no doubt that smoking during pregnancy is bad for a baby’s health, raising the risk of miscarriage, preterm birth, low birthweight and lower IQ. It also seems that doctors and midwives are struggling to find the time and resources to identify pregnant smokers and help them quit, so a breathalyser might seem like a good way of doing this.

NICE cites a recent study in which Zara Usmani of the University of Glasgow, UK, and her colleagues compared what 2584 pregnant women told healthcare workers about smoking with what measurements of carbon monoxide (CO) in their breath suggested was in fact the case. They found that 206 women who claimed to be non-smokers had CO levels higher than 2 parts per million (ppm), suggesting that they might in fact be smokers (Substance Abuse Treatment, Prevention, and Policy, DOI&colon; 10.1186/1747-597x-3-4).

They also concluded that around 27 per cent of smokers said they weren’t when asked at their first midwife appointment.

We’re NICE, really

NICE insists that the test won’t be compulsory, should be given in a non-judgemental way, and isn’t designed to catch women out. However, it recommends that only women with a CO reading of 7 ppm or more should be referred to services that will help them stop smoking. The assumptions behind Usmani’s study suggests that this cut-off will not detect a large number of smokers.

NICE adds that women who admit to being light or infrequent smokers should also be referred if they register a reading of 3 ppm, while “non-smokers” with a reading of more than 10 ppm should be advised about possible CO poisoning as the result of a gas leak.

All of this raises the question of what will happen to women who say they don’t smoke, but whose CO readings suggest they do – although they’re not as high as 7 ppm. A previous study found that a cut-off of even 6 ppm frequently missed people smoking less than six cigarettes a day and even some smoking 10 per day (Chest, DOI&colon; 10.1378/chest.128.3.1233).

Midwife or policewoman?

Will midwives turn a blind eye to women with similar readings who claim they don’t smoke, or will they judge them as liars – in which case, what will they do about it? I certainly wouldn’t want to be a midwife in that difficult position.

It’s true that breathalysing women may serve to make them more aware of the harm they could be doing to their babies, or warn them that their child is being exposed to smoke, even if they don’t admit to being the source.

However, it seems unlikely to stop die-hard smokers who don’t want to quit, or women who enjoy the occasional cigarette and don’t want to be made to feel guilty about it. Then there are the pregnant non-smokers like me, who may just feel resentful of being made to feel that we’re being watched.